Women are significant targets for antidepressant prescribing, and thus disproportionately experience both its positive and negative effects – we owe it to ourselves to ask more questions about how they work
Where were you when the University College London (UCL) dropped their viral study, concluding that there remains no clear evidence that serotonin levels are responsible for depression? I was in bed, filled with intrigue, sending the study to as many friends as possible. My texts read, “Can you even believe this?”
The major study published in Molecular Psychiatry last month suggests that depression is not likely caused by a chemical imbalance in the brain. The lead author of the study and Professor of Psychiatry at UCL, Joanna Moncrieff, remarked, “It is always difficult to prove a negative, but I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.”
This review is groundbreaking for obvious reasons, with Nina Massey from Metro highlighting that it challenges the widely held belief that serotonin deficiencies play a role in depression. The chemical imbalance argument is approximately believed by 85-90 per cent of the UK public. Serotonin is a chemical messenger in the brain that is supposed to act as a mood stabiliser, boosting your mood and producing healthy sleeping patterns. This is why we’re encouraged to partake in serotonin-boosting activities like exercising or being in direct sunlight. Most importantly, Massey notes, the review puts into question what antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs) really do for those with depression if there’s “no clear evidence” that a serotonin imbalance causes depression to start with.
In our day and age, questioning the workings of antidepressants feels scandalous, with so many of us having to convince the people in our lives that taking antidepressant medication for your mental health isn’t a sign of weakness and that it isn’t wrong. As someone who has had these heated conversations with their parents, this study should have upset me. It should have made me fiercely defensive of antidepressant medication. But I didn’t feel any of those things – instead, I felt excited.
When I started taking antidepressant medication in my third year of university, I was pretty apprehensive. My fears were primarily concerned with the side effects of these medications. I remember speaking to a close friend about my worries and confessing to her, embarrassed, that I was worried that my SSRI would impact my sex drive. She looked at me sympathetically, but her tone of voice highlighted her disappointment in me. “Your sex drive should not come before your mental health. There are more important things in life.” Her comment shut me up pretty quickly, but in the back of my head, it didn’t seem fair.
Once I was on my medication for a prolonged period, I asked some of my friends (who were also on antidepressants) if their meds ever made them feel numb. If they ever felt like they were just walking through life, with little sadness, yes, but also with little excitement? Most of them were also experiencing emotional bluntness due to their medication but seemed unphased by it. To them, it felt like a small price to pay for emotional stability. As much as I agreed, it once again felt unfair.
When the study came out, it felt like a world of possibility opened up for the way we could discuss depression and antidepressants, especially for women. Last month, The Telegraph reported that 5.5 million women were prescribed antidepressants in 2021/22, compared to 2.8 million men. There’s a range of reasons for this: from the historic medicalisation of women’s distress, to the social oppression women face, to the fact women are less conditioned to hide their feelings than men. Regardless of the reason, one thing remains true: women are significant targets for antidepressant prescribing and thus face the biggest brunt of its positive and negative effects.
“Women are significant targets for antidepressant prescribing and thus face the biggest brunt of its positive and negative effects”
From 1995 to 2000, an extensive study by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction was conducted to analyse reports of antidepressant-related sexual dysfunction. 1,022 patients were interviewed, and it concluded that men had a higher frequency of sexual dysfunction at 62.4 per cent, compared to women at 56.9 per cent. However, the women in the study had a higher severity of sexual dysfunction. In 2016, the medical journal Mayo Clinic Proceedings reported that one in six women in the US take antidepressants, and a substantial proportion of patients report some disturbance of sexual function while taking their medication. We already know that sexual dysfunction is generally higher for women than for men, with sexual dysfunction affecting 41 per cent of women worldwide. But something else that makes this particularly clear is the orgasm gap.
A Rutgers-led study published in the journal of Sex Roles in 2022 examined the well-established phenomenon in which men climax considerably more than women during heterosexual sex. The findings explain that since women have fewer orgasms than men, they inevitably desire less. While a thirst for sex, especially for good sex, can come across as selfish or unimportant, bad sex and sexual pleasure disparities are political issues. They are issues of “inequality of access to pleasure and self-determination”, as author and academic Katherine Angel has argued.
Even though there is a growing number of young women taking antidepressants, there are only a few studies on young women’s experiences with antidepressants. One study from 2019 analyses interviews with 16 young women who have been on antidepressants for differing amounts of time. Thematic analysis is used in this study to identify a range of potential self-related themes, with the participants expressing that they felt like they didn’t know themselves or did not feel like they were entirely themselves while on antidepressants. For example, one participant wondered, “Is what I’m feeling the drugs or is what I'm feeling me?” Another participant shared similar thoughts: “After six years (of being on antidepressants), you’ve kind of got to give up on that question (trying to make sense of your identity) if it’s left unanswered… You’re just going to be like, well, it’s not coming, so I’m going to stop trying.”
“The findings explain that since women have fewer orgasms than men, they inevitably desire less. While a thirst for sex, especially for good sex, can come across as selfish or unimportant, bad sex and sexual pleasure disparities are political issues”
It’s important to acknowledge that antidepressants do help so many people. For the Metro, Charlotte Colombo spoke to a number of people who use antidepressants and see them as a vital lifeline. But multiple things can be true at once: Antidepressants can help you, maybe even save your life, and, there can still be significant issues with these drugs that shouldn’t go under our radar. Writer and psychiatrist Linda Gask importantly tells Dazed that “it’s perfectly understandable to worry about being on antidepressant medication and wonder if you really need to take it. As someone who’s been on them, I’ve experienced that too. But it’s important not to stop taking antidepressants without discussing this with your doctor, or stop them suddenly.”
It can also be difficult to have these conversations about antidepressant medication when the alt-right uses any critique of them as fodder. Republicans have been long-term critics of SSRIs, with many of them pointing to the fact that SSRIs can produce side effects of suicidal ideation and violence in teenagers. They bring up this rare side effect, especially during mass shootings. For example, after the Robb Elementary School shooting in May, far-right US Senate candidate Blake Masters suggested that antidepressants were a factor in this mass shooting and others without presenting any evidence. Instead of passing comprehensive gun control legislation, Republican politicians and the alt-right would rather blame these acts on medication and mental illness.
Writing for Rolling Stone, EJ Dickson has importantly highlighted that Joanna Moncrieff, the author of the viral study, has been promoting fringe views about mental illness for years, such as linking SSRIs to aggressive and dangerous behaviour. She has also campaigned against vaccine mandates for health care workers, so it’s no surprise that alt-right commentaries like Matt Walsh and Tucker Carlson have embraced the study and are hijacking conversations around mental health. Many will feel like they’re on the wrong side of history by agreeing, even slightly, with a study the alt-right unanimously supports; however, the study’s findings aren’t entirely new. David Hellerstein, professor of clinical psychiatry at Columbia University Medical Centre and director of Columbia’s Depression Evaluation Service, explained to Rolling Stone that the chemical imbalance agreement is a “quaint and oversimplified shorthand that has been superseded by other explanations in clinical practice for a decade or more”.
The alt-right’s support of this study shouldn’t stop us from asking questions about antidepressants and wanting better from our medications and mental health services. Eliza McLamb, co-host of the feminist pop-culture podcast Binchtopia said it best in their “Medication Nation“ episode: “Presenting another narrative isn’t to say that what you think, believe or go through isn’t valid or true. It’s truly coming from a place of love; there could be a better, more whole way we can deal with these things (if only we question them). I want this to be a better framework. I want this to work better.” Because we all deserve more.
If you’re in the UK and are suffering from anxiety or depression, or have any questions about antidepressants, book an appointment with your GP or contact a mental health charity like Mind for help, advice and support. If you are currently on antidepressants, do not stop taking your medication without discussing this with your doctor.